Scaling up! Staff e-learning for a national take-home naloxone program.

Background: A staff e-learning course was developed to prepare for scaling up a national take-home naloxone (THN) program in Norway. The aims of the study were to (a) describe participant characteristics for those that completed a THN e-learning course, (b) compare opioid overdose knowledge scores before and after e-learning course completion, and (c) to explore subsequent THN distribution by those trained. Methods: This was a quasi-experimental pre-test, post-test longitudinal cohort study of individuals completing a THN e-learning course from April 2021 to May 2022. Frequency analyses were performed for participant characteristics and subsequent naloxone distributions at 1-week and 1-month follow-up. The opioid overdose knowledge scale (OOKS) was used to measure pre-test-post-test knowledge among participants. Wilcoxon signed-rank test was performed for comparison between pre-test and post-test. Effect size was calculated using Cohen criteria. Results: In total, 371 individuals were included in this study. Most were either nurses or social workers (n = 277, 75%). Participant knowledge increased by medium or large effect for all items measured. At 1-month follow-up, 15% reported naloxone distribution. During the study period, 94 naloxone kits were distributed. Major reasons for not distributing were "clients not interested", "workplace not distributing" and "workplace in process of distributing". Conclusions: Our findings suggest that an e-learning course is equally effective in terms of knowledge transfer as an in-person classroom setting, and may provide engagement in terms of naloxone distribution. However, our findings also emphasize the importance of clear implementation routines, including support from central coordinators to optimize the implementation process.

Prevalence of Patient Suicide and Its Impact on Health Care Professionals: A Systematic Review.

OBJECTIVE: This review aimed to examine the impact of patient suicide on health care professionals (HCPs), assess available support resources, and evaluate postvention (i.e., activities designed to support HCPs after a patient suicide) efforts. METHODS: An integrative systematic review was conducted to evaluate the prevalence of patient suicide and its emotional and professional impacts on HCPs. Searches were conducted in MEDLINE, Embase, CINAHL Plus, and the Cochrane Library in October 2021 and August 2022. Index terms and keywords were related to suicide, patients, and clinicians. Each article was assessed for quality with the Mixed Methods Appraisal Tool. RESULTS: Sixty-six relevant articles were identified. Across studies, the mean±SD percentage of HCPs who experienced a patient suicide was 51%±<1%. Fifty-eight (88%) articles reported on the emotional impact of patient suicide, and 50 (76%) reported on the professional impact of patient suicide. Thirty-three articles described a change in practice habits, which occurred for 51%-100% of professionals in these samples. Perceptions of support ranged widely, with 11%-87% of HCPs feeling that they received sufficient support. HCPs wanted formal support, including referral to counseling (12%-82%), more suicide prevention or postvention training (4%-70%), debriefing or supervision (41%-75%), formal case review (18%-20%), time off (12%), and legal assistance (4%). CONCLUSIONS: HCPs can be affected by patient suicide, regardless of practice setting. More information is needed to better understand the implementation of postvention services after patient suicide and to create practical and universally deliverable support services to meet HCPs' needs.

State Policy Strategies for the Workforce Emergency in Behavioral Health.

The United States is experiencing a behavioral health workforce emergency of unparalleled magnitude. After decades of inaction, selected states have launched significant efforts to strengthen the mental health and substance use disorder workforce. Seven state policy strategies in frequent use for addressing the current emergency are described, with examples for each. Links to more than 140 additional examples are also provided. States can draw on these strategies as they consider actions to strengthen their behavioral health workforce. There is a compelling need to act quickly while executive and legislative branches have a strong interest in solving this problem and federal support to the states is abundant.

An Investigation of the Knowledge of Infection Control Practices Held by Healthcare Professionals.

Background: Healthcare-associated infections (HAIs), arising from inadequate hygiene practices, significantly increase morbidity and mortality rates in hospitalized patients. Materials and Methods: This descriptive study involved 350 healthcare workers from private hospitals in Wuhan, China. Participants responded to a questionnaire with close-ended questions, distributed physically and via email. Data were analyzed using SPSS version 25.0. Results: The analysis indicated a gap in healthcare workers' knowledge of infection control, affecting hospital hygiene standards. About 60% of respondents hold a diploma or higher qualification. Conclusion: The findings underscore the importance of targeted training and educational initiatives in infection control procedures. A significant factor in hospitals' inadequate hygiene practices is the gap in staff training and knowledge.

Teaching trainees to implement functional communication training with multiple schedules: An evaluation of training effects and durability.

We evaluated the effects of behavioral skills training on improving participant implementation of functional communication training with multiple schedules when working with a confederate. Behavioral skills training produced mastery-level responding for all six participants who required training, providing the first empirically supported training for this functional communication training approach. Next, we assessed durability during training challenges with (a) procedural changes to the original protocol, (b) a novel confederate with different discriminative stimuli and reinforcers, and (c) relapsed confederate destructive behavior. Training effects degraded at least once for all participants and in 62% of training challenges, although continuing to expose the participant to the challenging situations or providing postsession booster training resolved the degradation in most cases. We discuss these findings in relation to their clinical implications and directions for future research.

The Impact of Trauma-Informed Training for a Youth Residential Center on Staff Attitudes and Behavior.

PURPOSE: Children with behavioral issues in residential care settings have high rates of trauma, with a range of trauma experiences such as abuse and neglect, issues with attachment, and multiple disruptions in placements. Staff in these settings should have an understanding of trauma, its impact, and how to engage in trauma-informed practice.The purpose of this study was to examine whether a trauma-informed training, developed specifically based on the identified needs of a residential group care facility, had an impact on future staff attitudes and behaviors. MATERIALS AND METHODS: A 3-h training was delivered by the researchers. Three identical sessions were provided to all 48 staff, regardless of education and role, across a 3-day period. Prior to the training, staff were given a pretest survey measuring components of trauma-informed (TI) practice that indicated how often the staff members engaged in TI practice. Thirty days later, the same participants completed a posttest survey to gauge if the training had an impact on their subsequent attitudes and behavior. RESULTS: There were improvements in many of the trauma-informed practice areas on the posttest survey. T-test analysis revealed five trauma-informed practice areas had improvements that were statistically significant from the pretest survey. DISCUSSION: The findings present the opportunity for recommendations for trauma-informed training development and delivery, as well as providing implications for the field of social work. CONCLUSION: This study demonstrates the feasibility of administering a trauma-informed training program and observing relatively rapid improvements in future attitudes and behavior among staff.

A National Snapshot of Training and Technical Assistance Needs Within the Mental Health Workforce.

OBJECTIVE: This report summarizes results from a national survey that aimed to assess the training and technical assistance needs of individuals who work in mental health. METHODS: A survey was distributed to mental health workers by 10 regional centers of a large, nationwide, federally funded training and technical assistance network during January-October 2021. RESULTS: A total of 2,321 individuals from 58 states and territories responded to the survey. The three training and technical assistance needs they indicated most frequently were equitable and culturally responsive services, co-occurring mental and substance use disorders, and mental health awareness and literacy. CONCLUSIONS: The survey findings reflect the continued need to address inequities in mental health services, particularly for communities of color. In addition, a cluster of topics (i.e., mental health awareness and literacy, trauma-informed care, crisis services, grief, and provider well-being) stemmed from the COVID-19 pandemic and its effects on the nation's mental health.

Comparison of Team-Based and Problem-Based Approaches to Dementia Care in Nursing Homes and Their Effects on Resident Outcomes During the COVID-19 Pandemic: A Mixed-Methods Study.

OBJECTIVES: Compare the effectiveness of 2 nonpharmacologic approaches to dementia care in nursing homes on 12- and 18-month resident outcomes, which was after the emergence of COVID-19. DESIGN AND INTERVENTION: A cluster randomized pragmatic trial, which included an embedded convergent mixed-methods design. Nursing homes were randomized to a team-based (TB) or problem-based (PB) intervention arm. SETTING AND PARTICIPANTS: Residents (n = 2658 at baseline) and staff (n = 327) from 52 nursing homes in the United States. METHODS: The exploratory quantitative analysis used a difference-in-differences model to compare the change in TB arm resident outcomes between baseline, 12 months, and 18 months relative to the PB arm using the Minimum Data Set 3.0. Outcomes included antipsychotic medication use, behavioral symptoms, wandering, and rejection of care. Staff interview data were analyzed in a 3-phase team-based rapid qualitative analysis approach, after which data were integrated. RESULTS: Rejection of care decreased by 5.9 percentage points in the TB arm relative to the PB arm at 12 months (95% CI -11.7 to -0.2). Emergent results indicated that COVID-19 visitation restrictions prevented PB staff from working with families to manage rejection of care as was done before the pandemic, whereas TB staff described using collaboration strategies not hindered by the pandemic. There was no statistically significant difference between arms in antipsychotic medication use, behavioral symptoms, and wandering at either follow-up period. When integrated, qualitative data provided contradictory information on antipsychotic medication use and confirmatory information on behavioral symptoms and wandering. CONCLUSIONS AND IMPLICATIONS: The exploratory nature and mixed results of the quantitative data analysis limited the ability to determine a clear benefit of one approach over the other. Findings suggest that dementia care delivery faced complex challenges during COVID-19 and required engagement from a broad range of nursing home staff underscoring the importance of equipping all staff with foundational dementia care knowledge.

A Cluster Randomized Trial: Mixed Methods Comparison of 2 Approaches to Promote Nonpharmacologic, Resident-Centered Dementia Care in Nursing Homes.

OBJECTIVES: Nursing home dementia care initiatives have prioritized nonpharmacologic approaches to manage behavioral symptoms. This study compares the effectiveness of 2 nonpharmacologic approaches on resident outcomes. DESIGN AND INTERVENTION: Cluster randomized controlled trial using a convergent mixed methods design to compare the team-based and problem-based approaches to dementia care. The team-based arm received facility-wide training, providing a shared language and knowledge across staff. The problem-based arm received discipline-specific web-based training for certain staff. SETTING AND PARTICIPANTS: Residents living with dementia (n = 2728) in 53 nursing homes; 327 staff. METHODS: Outcomes were antipsychotic medication use, behavioral symptoms, rejection of care, and wandering captured with the Minimum Data Set. Exploratory quantitative analysis compared change in outcomes between baseline and 6-month follow-up, across arms using a difference-in-difference model. Qualitative data were collected via staff interviews. Integration of quantitative and qualitative data determined whether these sources provided confirmatory, emergent, or contradictory information on outcomes. RESULTS: Resident wandering increased 3.51 percentage points (95% CI 0.6, 6.4) in the team-based arm compared to the problem-based arm, without increase in adverse events. Data integration confirmed this finding. Staff in the team-based arm described wandering as a positive coping strategy for the resident. We found mixed results for the other 3 outcomes. There was no statistically significant difference in antipsychotic medication use across arms, but staff interviews did reveal differences. There were trends of increased behavioral symptoms in the team-based arm and increased rejection of care in the problem-based arm (neither statistically significant), which were confirmed by qualitative findings. CONCLUSIONS AND IMPLICATIONS: Integration results suggest a benefit for resident wandering in the team-based approach, compared with the problem-based approach. Although findings are exploratory, training for all nursing home staff that accounts for diverse education and training needs may influence care delivery and have benefits for residents living with dementia.

Perspectives of Nursing Home Staff: Application of Dementia Training Approaches.

Non-pharmacological strategies are prioritized to manage dementia-related symptoms in nursing homes (NHs). A multiple-case study design, embedded within a pragmatic trial, examined NH staff perspectives of applying a team-based (TB) or problem-based dementia training program to resident care. A purposive sample of staff was recruited from 23 NHs to participate in one-on-one interviews, which were analyzed using a rapid qualitative approach. Both approaches yielded staff who were able to apply their training to resident care. Staff described similarities in communication strategies, family interactions, recognizing sources of behaviors, providing comfort, and ensuring resident safety. In addition, staff demonstrated increased self-efficacy when caring for residents. Differences emerged for team collaboration, engaging residents, and managing behaviors. Among TB staff, training impacted how staff cared for residents and increased teamwork. Leaders may want to consider the benefits of each approach as they deliberate on which dementia care training to provide to their staff.

Effects of applying blended learning based on the ADDIE model in nursing staff training on improving theoretical and practical operational aspects.

Objective: To assess the impact of blended learning, based on the ADDIE model, on theoretical and practical aspects of nursing staff training. Methods: Retrospective analysis of data from 87 nursing staff members in Xi'an Qinhuang Hospital divided into control (n = 43) and observation (n = 44) groups. The control group received conventional training, while the observation group underwent blended learning. Comparative analysis included theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction. Results: The observation group showed significantly higher theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction compared to the control group (p < 0.05). Conclusion: Blended learning based on the ADDIE model enhances nursing staff training outcomes, improving theoretical knowledge, practical skills, self-directed learning, critical thinking, and teaching satisfaction. This approach presents a promising method for enhancing nursing education and warrants further implementation in clinical settings.

Measurement of Patient-Level Outcomes After Implementation of Trauma-Informed Care Training in the Emergency Department: A Pilot Study.

INTRODUCTION: Trauma-informed care has been posited as a framework to optimize patient care and engagement, but there is a paucity of data on patient-level outcomes after trauma-informed care training in health care settings. We sought to measure patient-level outcomes after a painful procedure after implementation of trauma-informed care training for ED staff. METHODS: As part of a quality improvement initiative, we trained 110 ED providers in trauma-informed care. Next, we prospectively recruited patients who had undergone a painful procedure to complete a survey to assess several patient-level outcomes, such as anxiety reduction and overall experience of care. We compared differences in patient outcomes for those who were treated by providers in the trauma-informed care intervention group with those who were treated by providers who did not complete the training (usual care). RESULTS: One-hundred forty-seven adult patients completed survey measures (n = 76 trauma-informed care intervention group; n = 71 usual care group) over a 1-month period. Most patients offered the highest rating for all ED staff-related questions. We found no significant differences in assessment of patient-reported outcomes based on intervention versus usual care. DISCUSSION: Our trauma-informed care training did not seem to have a significant effect on our selected patient outcomes. This may be caused by the training itself or the challenges in measurement of the patient-level impact of trauma-informed care training owing to the study design, setting, and lack of standardized tools. Recommendations for future study of trauma-informed care training and measuring its direct impact on patients in the ED setting are discussed.

Evaluation of a training package to teach pairing procedures.

Pairing is a commonly recommended practice used to build rapport and create positive therapeutic environments. However, there are limited evaluations of training procedures to teach pairing skills to direct-care staff. The purpose of the present study was to formalize and improve the efficiency of the training process for the initial stages of pairing using video modeling with embedded voice-over instructions plus performance feedback. Participants included three dyads of behavior technicians and children with autism. The results indicated that the training package increased the consistency of pairing implementation. These outcomes were maintained in a novel setting and for up to 4 weeks following training. We also measured relevant child behaviors such as joint attention, engagement, indices of happiness, and calm. Specific areas for future research are described.

Implementing Montessori approaches after training: A mixed methods study to examine staff understanding and movement toward action.

Background: This paper uses Normalization Process Theory (NPT) to examine staff impressions of Montessori-based program training and implementation at Veterans Affairs Community Living Centers (VA CLCs; nursing homes). Methods: We conducted a mixed-methods evaluation of Montessori Approaches to Person-Centered Care (MAP-VA) at eight VA CLCs. Trainings were conducted as either a live virtual course or a pre-recorded asynchronous class. Two NPT constructs, coherence building and cognitive participation, informed qualitative interview questions, surveys, and analyses focused on staff movement from knowledge to action during initial implementation. Data collection included staff-completed standardized post-training exams (N = 906), post-training evaluations (N = 761), and optional validated surveys on perceptions of Montessori training (N = 307). Champions (peer-leaders) from each CLC completed semi-structured qualitative interviews post-training (N = 22). Findings: The majority of staff (83%-90%) passed all courses. Staff evaluated the training highly (80%+ agreement) on learning relevant new knowledge and confidence applying new skills. On average, staff felt MAP-VA would become a normal part of their work (7.68/10 scale), and reported increased familiarity with Montessori approaches after training (p = .002). Qualitative interview data from staff trained in Montessori supported three themes concordant with the NPT dimensions of coherence building and cognitive participation. (1) Coherence regarding Montessori: staff demonstrated an understanding of the program and mentioned the benefits of Montessori compared to their previous usual routines. Cognitive participation or engagement with Montessori: (2) staff had positive feelings about Montessori principles/applications and demonstrated a willingness to try the Montessori approach, and (3) staff made sense of the new intervention through early rehearsal of Montessori principles/practices and recognized opportunities for using Montessori in future interactions. Conclusions: Montessori virtual training resulted in high levels of coherence and cognitive participation among multidisciplinary staff, evidenced by high knowledge, self-efficacy, and readiness to act. The asynchronous and synchronous trainings were accessible, relevant, and supported diverse learners.

Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial.

BACKGROUND: Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting. METHODS: Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140). RESULTS: With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points. CONCLUSIONS: The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.

Experience of violence and attitudes of staff members towards coercion in psychiatric settings: observational study.

BACKGROUND: Among important dimensions related to the use of coercive measures, professionals' attitude towards coercion is of particular interest. Little is known about how experiences of violence in the workplace might influence these attitudes. AIMS: The present study aimed to investigate potential correlates of attitudes towards coercion, especially experiences of violence in the workplace. METHOD: Mental health professionals were contacted through an online survey to assess their attitudes towards coercion using the Staff Attitude to Coercion Scale (SACS). The three subscales of the SACS (critical, pragmatic and positive attitudes) were analysed in a multivariate multiple linear regression, using a set of covariates including experiences of violence in the workplace. We hypothesised that experience of violence in the workplace would correlate with less critical attitudes of staff members towards coercion. RESULTS: A total of 423 professionals were included in the regression analysis. Age, professional category, feeling of insecurity, having witnessed or used coercion, and the emotional burden associated with coercive measures had a joint significant effect on the three SACS subscales. A feeling of insecurity, but not the experience of violence, was associated with a less critical, more positive appraisal of coercive measures. The emotional burden related to the use of coercion was associated with a more critical attitude. CONCLUSIONS: The present results highlight the importance of considering staff members' training and well-being regarding their feelings of insecurity when addressing attitudes towards coercion. The experience of patients should be integrated into staff training and coercion reduction programmes.

Introducing Compassionate and Relational Enquiry (CARE): A Three-Day Training for Mental Health Clinicians on Relational Ways of Working.

Research shows that, in mental healthcare, empathy and active listening skills play a fundamental role in the therapeutic relationship. Despite this, clinicians receive little training in cultivating these qualities, and there is a dearth of training in therapeutic relationships and relational care in this field more generally. In response to this paucity of training, a new intensive three-day training programme has been developed called Compassionate and Relational Enquiry (CARE). The CARE training programme has recently been delivered to a number of mental health teams in different boroughs of an NHS Trust and has undergone several rounds of redevelopment. This paper outlines the CARE training programme's objectives and mode of delivery, and subsequently presents questionnaire results from recent CARE trainees regarding their experience of the nature and utility of the training. Four main themes emerged from responses to the question of the utility of the training, these were 'A shift towards more person-centred care', 'Strengthens the therapeutic relationship', 'Facilitates more collaborative care with patients and their families' and 'Development of new skills and therapeutic techniques'. The paper concludes by discussing the potential of this training to help forge a substantial shift in the culture of mental health services in a systemic way.

Approaching sustainability in Laboratory Medicine.

INTRODUCTION: Clinical laboratories and the total testing process are major consumers of energy, water, and hazardous chemicals, and produce significant amounts of biomedical waste. Since the processes in the clinical laboratory and the total testing process go hand in hand it mandates a holistic, and comprehensive approach towards sustainability. CONTENT: This review article identifies the various sources and activities in Laboratory Medicine that challenge sustainability and also discusses the various approaches that can be implemented to achieve sustainability in laboratory operations to reduce the negative impact on the environment. SUMMARY: The article highlights how the integration of technological advancements, efficient resource management, staff training and sensitization, protocol development towards sustainability, and other environmental considerations contributes significantly to a sustainable healthcare ecosystem. OUTLOOK: Variables and resources that negatively impact the environment must be identified and addressed comprehensively to attain a long-lasting level of carbon neutrality.

Examining State Licensing Requirements for Select Master's-Level Behavioral Health Providers for Children.

OBJECTIVE: The authors examined licensing requirements for select children's behavioral health care providers. METHODS: Statutes and regulations as of October 2021 were reviewed for licensed clinical social workers, licensed professional counselors, and licensed marriage and family therapists for all 50 U.S. states and the District of Columbia. RESULTS: All jurisdictions had laws regarding postgraduate training and license portability. No jurisdiction included language about specialized postgraduate training related to serving children and families or cultural competence. Other policies that related to the structure, composition, and authority of licensing boards varied across states and licensure types. CONCLUSIONS: In their efforts to address barriers to licensure, expand the workforce, and ensure that children have access to high-quality and culturally responsive care, states could consider their statutes and regulations.